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The United Nations have labelled April 7 World Health Day. A day to pay explicit attention to health issues. Since our focus is trans* and inter*, or differently (and more universally) put: gender identity, gender expression and sex characteristics, this is what we will look into.

Luxury

For transgender persons, or trans* people, or gender variant/diverse people, having a good health is often a luxury they cannot afford. Because they are not recognized as a group in need of specific health care (or even health care at). In many parts of the world including enlightened Europe, wishing to adapt your body’s sex characteristics is a frowned upon phenomenon. Both the general public and the medical sector may despise you for your needs.

Insurance

The next issue is getting the health care covered by insurance. Of the countries that provide health care to relieve the plight of trans* people, most cover maybe the ‘basics’ and then still often on extraneous conditions. These so-called basics are not by definition what the trans* person asks. Because being trans* does not only concern those people who need to ‘switch’ genders for their well-being, but every trans* person who is in need of any health care to increase their well-being with their gendered and sexed body. Some people may need hormone replacement therapy because their natal sex hormones don’t agree with them. Some need to only get rid of (the largest part of) their breasts. And given the choice, the percentage of trans* women that insists in getting rid of their original genitals is not that high. In the Netherlands only 12% of the whole trans* population (estimated at 2 to 3% of the population) decides for medical assistance. Communication from Spain indicates a similar percentage.

Fate

In most countries doctors don’t agree with prescribing hormones or doing surgery upon a patient unless a psychologist has done a thorough assessment of the care user’s mental health and observes the presence of “Gender Identity Disorder” or “Gender Dysphoria”. That process of establishing the diagnosis can easily aggravate the presupposed dysphoria (a word that actually refers to severe depression, and by virtue of that is not a good term). When left to the discretion of a prejudiced medical profession, that has no good understanding of sexual orientation and gender identity (and expression) phenomena, they will try to explain things away, but not legitimize the existence of gender diversity. The higher the level of morals conservatism, the higher the chance trans* people will meet this fate and only can progress medically assisted gender transition with a diagnosis of severe mental disorder.

Standards

Also in the progressive Netherlands you cannot easily enter medically assistance with gender transition. Where the Standards of Care for transgender health care states that informed consent is the way to go, the Amsterdam gender team still insists in a lengthy psychological evaluation and in case you may encounter practical trouble (intensifying ‘dysphoria’, growing life problems for non conforming ..) they may prolong evaluation or when already on HRT, suggest you to lower the dosage. As if that were the issue. Doing so leads to iatrogenic increase of mental instability. Which in turn leads to a decrease of the patient’s health.

Assessment

Another issue that weirdly is coupled to a trans* person’s health, is Legal Gender Recognition and the preconditions for that. In Europe 33 countries require psychological or medical interventions before recognizing a trans* person’s wish to change their gender assignment; 19 still require sterilization and genital realignment. Only two states in the world give the possibility to change one’s gender assignment with no strings attached: Argentina, and Malta. Denmark comes next, but still requires a half-year wait (and being over 18 y.o.). Everywhere else, where there are regulations, psychological assessment is the least invasive requirement, also in the Netherlands. Only two to three countries take trans* people seriously. And only one of these has provisions for a non-male/non-female reassignment.

Malta

Laws and regulations can have an important effect on trans and inter* persons’ well-being. They regulate the conditions for legal gender change, for medical assistance: which interventions are available at all, which ones are insurance funded? For intersex (or inter*, because it can also be an identity and those more ‘intergender’ and the asterisk in both inter* and trans* indicates a vastness in possibilities). Only one state in the whole world, one state out of more than 192 states, prohibits explicitly that sex characteristics get adapted to a social ideal of having genitals clearly distinguishable as male or female. Everywhere but in Malta this is still legal, and standing practice.Progress

Engaging in these usually non-consensual surgeries is a gross violation of a person’s dignity and personal autonomy. Intersex genital mutilations – usually performed on minors – equals forced sterilisation of women for belonging to the wrong ethnic group (forbidden by the European Human Rights Court en the UN!). When asked a paediatrician they sometimes agree that in the past many errors have been made, but nowadays medical science is so much better that the results are incomparable with the sorry state of technique and results of twenty-five years ago. By using that argument they still deny people their right to bodily autonomy, to decide for themselves about their body. They preclude being OK with those genitals (or gonads or chromosomes), with their body and their life.

Power

The health of a person considered physically or mentally deviant is the explicit object of power play, of medical, psychiatric and legal paternalistic laws and practices. That goes against the most basic rights and that alone already is pretty bad for one’s health.

In the early morning of the 18th of December 2013 the Dutch Senate passed the proposal for updating the existing legislation of now 18 years old. It has been a long and bitter fight, in which some core demands have been realised, but it is not over yet.Continue reading

From midnight tonight six trans* activists In Andalusia, Spain will start a permanent hunger strike until either the bill for better trans legislation that is stuck, will be really introduced in Parliament or until they die.Continue reading

As you may have seen on the social media already, or on trans mailing-lists: change in Dutch gender recognition legislation just took a big leap this afternoon of 9 April 2013.

Already five years ago Dutch trans people contacted the minister for Emancipation (and Education, Science and Culture) complaining about the ridiculous and human rights violating legislation that goes back to 1985. The minister then promised to get it changed fast.

Fast forward to 2011. Human Rights Watch presents a report on the situation of trans people in the Netherlands and precisely then a watered down proposal is presented. National and international trans organizations complain heavily, only being happy with the removal of the requirement for medical (physical) interventions. After discussions and comments in the first (written) lecture in parliament some improvements are made.

Last week the debate took place and today the change proposal has been voted to continue to the next round, the Senate. After that only a signature of the head of state is needed for the law to come in to force.

What does the law entail when accepted?

Every person with a Dutch birth certificate or residence can amend it without medical intervention. If at least 16 years old.

Provided with an expert letter confirming the applicant’s durable conviction being of the other gender. The expert is to be a doctor or psychologist of the gender teams. Others are to be cleared by the gender teams.

Go to the civil registry and it will be adapted.

Evaluation of the law after five years

Amendments have been brought to the floor to change some important aspects:

LGBT organisations (incl. the trans organisation) want a wider group of experts to be authorized to write an expert opinion, like social workers, reverends, sexologists, gender experts, trans organisations … Alas: rejected

It has been requested to bring the evaluation term of the law back to three years because of the rapid developments in the field. Alas: rejected

Lower the age limit to 12 years. Alas. Also rejected

Also it has been requested to investigate the possibility for a third gender marker or nothing at all. This motion has been accepted. Results are to be in within two years (to prevent the ongoing UK “investigations”). The precise order has not yet been commissioned.

All in all a good result, but it leaves still room for improvement on essential points. Life for trans people will be enormously improved, probably per Jan 1, 2014 as hope is the changes will then have effect.

As a note: this has no implications for the availability of trans specific health care. These issues are not legally coupled.

The proposal for change of the existing gender recognition legislation in the Netherlands is out. This proposal will be debated on the floor. It is – as the previous version – not good enough. Actually it hardly changed since last time we saw it.

The news came in the mail. An update of the website of the Justice and Security ministry. The proposal for change of gender recognition legislation is ready for second reading. Written comments have been worked through and answered. The secretary of state for Justice and Security apparently was not impressed by the questions and by the comments of the trans-movement. We are not impressed by him. Never were. Some refreshers:

It took a Human Rights Watch report for government to come up (immediately!) with a proposal for change.

This after some three years of talking and checking back with the legal advisor of government and of several ministers speaking of their worry for the current situation.

Extensive comments for all national (TNN, COC, ..) and international (TGEU, HRW, GATE) stakeholders have been given.

Then again the government needed reminding not to stall. Promise is debt.

Comments again from national actors went to all political parties that took up several important questions but – of course not required – government took up maybe one point

The trans movement is only taken seriously where it is advantageous for government

So what does the proposal of Dutch neoliberal cum ex-social ex-democrats comprise?

An expert in gender dysphoria must check if you are sincere and that you have an enduring conviction. If you are not deluded or doing it out of delusion. If it is not done out of criminal intent

Appointed gatekeepers consist of current doctors and psychologists gender teams, and others accorded by the ministry. They proposed a nice package deal.

“Real Life Experience” or long time living in the role of preference has no influence on the legal part of the process. But gatekeepers may take that more serious than other expressions of trans-gender

You must be at least 16 years of age

After giving birth as a (legal) man you will still be the mother. Mater semper certa est. No wishes to make pedigree law gender neutral. Tendency is more re-biologising

Good thing: no need for hormonal or surgical treatment

Good thing 2: no court procedure necessary anymore

The law will be evaluated after five years

So, two or three important good changes, and lots of lost opportunities in this proposal. Where good thing 3 may be that the expert opinion may not be a diagnosis. But how will this go if the applicant later goes on to medical procedures? Will it then be taken as a (psycho) medical diagnosis? So you must be gender dysphoric to get help?

Government gave in on the easy part: the world moves to outlaw coerced medical treatment (actually already for some time). Lately by UN Special Rappporteur Juan Méndez who now moves required and coerced medical interventions for trans people and infant genital mutilation as with intersex children explicitly into the Convention against Torture (absolute, never relative, always enforceable human rights law).

Yogyakarta Principle 18 is about this issue: medical maltreatment, unnecessary medical interventions. The Yogyakarta Principles on human rights regarding sex, gender and sexuality, that Dutch government says to wholly support.
Principle 3 however is about recognition before the law. Apart from making change easier than before, government still requires trans people to see an expert in effing gender dysphoria. who must check if we feel to belong to The Other Sex. We are never the experts on us. The trans movement has not been consulted on the issue of the expert, the medical experts have.

It is a long way to Tipperary. And an even longer one to gender justice.

Vreerwerk

A Dutch name for thorough LGBTI advocacy and gender education. More than ten years on the theatre of transgender and human rights with an extra-ordinary personal story, I am the 'tranny' for your cause.